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Clin J Am Soc Nephrol. 2020 Jan 7. pii: CJN.05070419. doi: 10.2215/CJN.05070419. [Epub ahead of print]

In-Hospital Cardiac Arrest Resuscitation Practices and Outcomes in Maintenance Dialysis Patients.

Author information

1
Duke Clinical Research Institute.
2
Division of Cardiology.
3
Department of Biostatistics and Bioinformatics.
4
Division of General Internal Medicine, and.
5
Division of Nephrology, Duke University Medical Center, Durham, North Carolina; and.
6
Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
7
Duke Clinical Research Institute, patrick.pun@duke.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Patients on maintenance dialysis with in-hospital cardiac arrest have been reported to have worse outcomes relative to those not on dialysis; however, it is unknown if poor outcomes are related to the quality of resuscitation. Using the Get With The Guidelines-Resuscitation (GWTG-R) registry, we examined processes of care and outcomes of in-hospital cardiac arrest for patients on maintenance dialysis compared with nondialysis patients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

We used GWTG-R data linked to Centers for Medicare and Medicaid data to identify patients with ESKD receiving maintenance dialysis from 2000 to 2012. We then case-matched adult patients on maintenance dialysis to nondialysis patients in a 1:3 ratio on the basis of age, sex, race, hospital, and year of arrest. Logistic regression models with generalized estimating equations were used to assess the association of in-hospital cardiac arrest and outcomes by dialysis status.

RESULTS:

After matching, there were a total of 31,144 GWTG-R patients from 372 sites, of which 8498 (27%) were on maintenance dialysis. Patients on maintenance dialysis were less likely to have a shockable initial rhythm (20% versus 21%) and less likely to be within the intensive care unit at the time of arrest (46% versus 47%) compared with nondialysis patients; they also had lower composite scores for resuscitation quality (89% versus 90%) and were less likely to have defibrillation within 2 minutes (54% versus 58%). After adjustment, patients on maintenance dialysis had similar adjusted odds of survival to discharge (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 0.97 to 1.13), better acute survival (OR, 1.33; 95% CI, 1.26 to 1.40), and were more likely to have favorable neurologic status (OR, 1.12; 95% CI, 1.04 to 1.22) compared with nondialysis patients.

CONCLUSIONS:

Although there appears to be opportunities to improve the quality of in-hospital cardiac arrest care for among those on maintenance dialysis, survival to discharge was similar for these patients compared with nondialysis patients.

KEYWORDS:

Centers for Medicare and Medicaid Services (U.S.); Dialysis; Epidemiology and outcomes; Medicaid; Medicare; United States; cardiovascular disease; chronic kidney failure; heart arrest; humans; intensive care units; logistical models; registries; renal dialysis

PMID:
31911423
DOI:
10.2215/CJN.05070419

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